Cefepime Neurotoxicity in Acute Kidney Injury: The Importance of Renal Dosing

Cefepime is widely used in sepsis owing to its broad spectrum of activity with coverage against Pseudomonas. Though it is usually well-tolerated, in the presence of certain risk factors, renal impairment, high doses, and critical illness, it is associated with the development of neurotoxicity. Those most susceptible are at high risk for developing complications of their underlying illness and the clinical manifestations of cefepime-related neurotoxicity are nonspecific, with reduced level of consciousness, confusion, myoclonus, and seizures, thus a high index of suspicion is required to make a diagnosis. The management includes drug discontinuation, seizure prophylaxis in the right clinical setting, and hemodialysis in severe cases. This case reinforces the need to renally adjust medications in the setting of acute kidney injury to avoid uncommon complications while using common medications.